Provider Demographics
NPI:1417722760
Name:HERNANDEZ SIMMONS, MARIA EUGENIA
Entity Type:Individual
Prefix:
First Name:MARIA EUGENIA
Middle Name:
Last Name:HERNANDEZ SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 SUNNY PINE WAY APT C2
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33415-8993
Mailing Address - Country:US
Mailing Address - Phone:561-335-4080
Mailing Address - Fax:
Practice Address - Street 1:1490 S MILITARY TRL STE 7
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-9141
Practice Address - Country:US
Practice Address - Phone:561-323-2552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-286761106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty